A small percentage of men have complained of a shortened penis after prostate cancer treatment, research reveals.
In a study conducted by researchers from Dana-Farber/Brigham and Women's Cancer Center in Boston, some men have lamented that the change in their penis has interfered with intimate relationships and caused them to regret their choice of treatment.
The study's findings, which are being published in the January issue of the journal Urology, are based on surveys completed by physicians of 948 men treated for prostate cancer and who had suffered a recurrence of the disease.
Complaints were more common in men treated with radical prostatectomy (surgical removal of the prostate) or male hormone-blocking drugs combined with radiation therapy, according to the study.
No men reported a perceived shortening of their penis following radiation therapy alone.
Things HuffPost UK Lifestyle learnt about prostate cancer in 2012
New Advice On Prostate Cancer Screening
This year, the U.S. Preventive Services Task Force <a href="http://www.npr.org/blogs/health/2012/05/21/153234671/all-routine-psa-tests-for-prostate-cancer-should-end-task-force-says">recommended <em>against</em> routine prostate cancer screening</a> for men of all ages, noting its small benefits compared to the harms, published in the <em>Annals of Internal Medicine</em>. "We think the <a href="http://www.npr.org/blogs/health/2012/05/21/153234671/all-routine-psa-tests-for-prostate-cancer-should-end-task-force-says">benefit is very small</a>," Dr. Michael LeFevre, a member of the task force, told NPR's Shots blog. "Our range is between zero and one prostate cancer death avoided for every thousand men screened," which is minuscule compared to lives saved for screenings for conditions like colorectal cancer. A study published at the beginning of the year in the <em>Journal of the National Cancer Institute</em> seemed to back up the recommendations, noting that routine prostate cancer screening didn't seem to make a <a href="http://www.huffingtonpost.com/2012/01/06/prostate-cancer-screening-psa-test-deaths-men_n_1190558.html">difference in the risk of dying from prostate cancer</a>, Reuters reported. However, the American Society of Clinical Oncology issued advice after the USPSTF's recommendation, saying that whether a man gets routine prostate cancer screening should <a href="http://www.huffingtonpost.com/2012/07/17/prostate-cancer-screening-test-man-life-expectancy_n_1679499.html">depend on his life expectancy</a>. For example, men who aren't expected to live more than another 10 years should be discouraged from PSA testing, the Associated Press reported.
PSA Testing Could Mean Fewer Cases Of Deadly Prostate Cancer
To add more to the research on prostate cancer screening, a study in the journal <em>Cancer</em> showed that routine PSA testing is linked with 17,000 fewer cases of the deadliest form of prostate cancer. "By not <a href="http://www.webmd.com/prostate-cancer/news/20120730/study-psa-testing-cuts-worst-prostate-cancers">using PSA tests</a> in the vast majority of men, you have to accept you are going to increase very serious metastatic disease threefold," study researcher Dr. Edward Messing, M.D., the chief of urology at the University of Rochester Medical Center, told WebMD. Specifically, researchers calculated that without routine prostate cancer screenings through PSA testing, 25,000 men would have been diagnosed with <a href="http://www.webmd.com/prostate-cancer/news/20120730/study-psa-testing-cuts-worst-prostate-cancers">metastatic prostate cancer</a> (a deadly form of prostate cancer where it has spread beyond the prostate to elsewhere in the body) in 2008, compared with the 8,000 who were actually diagnosed with metastatic prostate cancer that year, WebMD reported.
Working The Night Shift Could Raise Your Risk
<a href="http://www.huffingtonpost.com/2012/10/25/night-shift-prostate-cancer-health_n_2003392.html">Working the night shift</a> is associated with a 2.77-times increased risk of prostate cancer, according to a study in the <em>American Journal of Epidemiology</em>. The study, conducted by Canadian researchers included 3,137 men with cancer and 512 men without cancer. The researchers also found that <a href="http://www.huffingtonpost.com/2012/10/25/night-shift-prostate-cancer-health_n_2003392.html">working the night shift</a> raised the risk of lung, colon, bladder, rectal and pancreatic cancers, as well as non-Hodgkin's lymphoma.
Surgery May Not Be The Best Option For Everyone With Prostate Cancer
Surgery may not always be the best option for men whose prostate cancer is detected with an elevated PSA (prostate-specific antigen) level, according to a study in the <em>New England Journal of Medicine</em>. For men with early prostate cancer who received a <a href="http://abcnews.go.com/Health/ProstateCancer/surgery-rarely-best-prostate-cancer-study-suggests/story?id=16805902#.UJrg9m_A_kh">radical prostatectomy</a> (prostate-removal surgery), 47 percent died after 12 years, while 49.9 percent of men who just underwent observation died after 12 years, ABC News reported. Plus 81 percent of men who underwent the radical prostatectomy <a href="http://www.webmd.com/prostate-cancer/news/20120718/prostate-cancer-surgery-may-not-always-up-survival">experienced erectile dysfunction</a> in the two years following, and urinary incontinence plagued 17 percent of the men, WebMD reported. However, ABC News did note that men whose <a href="http://abcnews.go.com/Health/ProstateCancer/surgery-rarely-best-prostate-cancer-study-suggests/story?id=16805902#.UJrg9m_A_kh">PSA scores were extremely high</a> -- above 10 -- benefited from receiving surgery, indicating that the study may suggest rather <em>which</em> men may benefit most from receiving a radical prostatectomy for their prostate cancer.
Aspirin Could Help Prostate Cancer Patients Live Longer
Prostate cancer patients who <a href="http://www.nytimes.com/2012/08/28/health/research/regular-aspirin-use-may-aid-prostate-cancer-recovery-study-finds.html">take aspirin</a> could cut their risk of dying from the disease, Harvard researchers reported this year. <em>The New York Times</em> reported on the study, published in the <em>Journal of Clinical Oncology</em>, which showed that taking aspirin cut in half the risk of <a href="http://www.nytimes.com/2012/08/28/health/research/regular-aspirin-use-may-aid-prostate-cancer-recovery-study-finds.html">dying of prostate cancer</a> over a decade -- 8 percent of aspirin-nontakers died, compared with 3 percent of aspirin-takers.
Circumcision Could Affect Risk
Circumcision -- or the removal of a man's foreskin before he has sex for the first time -- is linked with a <a href="http://www.huffingtonpost.com/2012/03/12/circumcision-prostrate-cancer_n_1339047.html">lower risk of developing prostate cancer</a>, Fred Hutchinson Cancer Research Center scientists found this year. The findings, published in the journal <em>Cancer</em>, shows that prostate cancer risk for <a href="http://www.huffingtonpost.com/2012/03/12/circumcision-prostrate-cancer_n_1339047.html">men who are circumcised</a> before the first time they have sex is 15 percent lower, compared with uncircumcised men. While Dr. Andrew Freedman, who is on the American Academy of Pediatrics' circumcision task force but was not involved in the study, found the findings thought-provoking, he told HuffPost in an earlier article that "this kind of epidemiological research -- how A affects B, and B affects C -- is very difficult to do and makes it very difficult to account for confounding variables."
Pan-Fried Meat Could Raise Risk
Including <a href="http://www.huffingtonpost.com/2012/08/20/pan-fried-meat-cancer-prostate-_n_1798970.html">pan-fried meat</a> in your weekly meal rotations is linked with a higher risk of prostate cancer, University of Southern California researchers found. Specifically, men who eat one-and-a-half servings of red meat that's been pan-fried each week have a 30 percent <a href="http://www.huffingtonpost.com/2012/08/20/pan-fried-meat-cancer-prostate-_n_1798970.html">increased risk of advanced prostate cancer</a>. And men who eat two-and-a-half servings of the food have a 40 percent increased risk. Hamburger meat in particular -- compared with a red meat like steak -- seemed linked with the increased risk, according to the <em>Carcinogenesis</em> study. And while not a red meat, pan-fried poultry also seemed linked with the <a href="http://www.huffingtonpost.com/2012/08/20/pan-fried-meat-cancer-prostate-_n_1798970.html">increased prostate cancer risk</a> (while <em>baked</em> poultry was associated with a lower prostate cancer risk).
Genetic 'Signatures' Could Predict Aggressive Disease
Genes could hold a clue to who will go on to <a href="http://www.huffingtonpost.com/2012/10/09/prostate-cancer-genetic-signatures-aggressive-tumors_n_1949724.html">develop aggressive prostate cancer</a>, researchers found this year. Reuters reported on the <em>Lancet Oncology</em> study, showing aggressive tumors might be able to be predicted by two <a href="http://www.huffingtonpost.com/2012/10/09/prostate-cancer-genetic-signatures-aggressive-tumors_n_1949724.html">genetic "signatures</a>": <blockquote>Researchers in Britain and the United States found that by reading the patterns of genes switched on and off in blood cells, they could accurately detect which advanced prostate cancer patients had the worst survival rates.</blockquote>
Blood Pressure Could Affect Risk Of Dying From Prostate Cancer
The risk of dying from prostate cancer is higher if you also<a href="http://www.huffingtonpost.co.uk/2012/10/23/blood-pressure-prostate-cancer-deaths_n_2004582.html?just_reloaded=1"> have high blood pressure</a>, European researchers found. Specifically, hypertension was linked with a 62 percent increased risk of dying for people with prostate cancer. "When we looked to see if the metabolic factors are related to an increased risk of getting or dying from prostate cancer we found a relationship with <a href="http://www.huffingtonpost.co.uk/2012/10/23/blood-pressure-prostate-cancer-deaths_n_2004582.html?just_reloaded=1">death from the disease and high blood pressure</a>," study researcher Christel Haggstrom, of Umea University, told HuffPost UK. "There was also a link to high BMI but blood pressure had the strongest association to increased risk. The results for BMI are in line with previous findings in large studies."
Green Tea Is Good
Research presented at the annual meeting of the American Association for Cancer Research this year showed that drinking green tea could <a href="http://www.eurekalert.org/pub_releases/2012-10/aafc-gtr101112.php">help ward off inflammation</a> in men with prostate cancer who are about to undergo prostate-removal surgery. "Our study showed that <a href="http://www.eurekalert.org/pub_releases/2012-10/aafc-gtr101112.php">drinking six cups of green tea</a> affected biomarkers in prostate tissue at the time of surgery," study researcher Susanne M. Henning, Ph.D., R.D., of the David Geffen School of Medicine at the University of California Los Angeles, said in a statement. "This research offers new insights into the mechanisms by which green tea consumption may reduce the risk for prostate cancer by opposing processes such as inflammation, which are associated with prostate cancer growth."
Living Longer With Prostate Cancer
In this medical video learn more about the treatments that are enabling men to live longer with prostate cancer.
Twenty-five men complained of smaller penises after treatment – 3.73% for surgery, 2.67% for radiotherapy plus androgen deprivation therapy (ADT), and 0% for radiotherapy alone. Radiotherapy included both radiation administered by an external x-ray machine, and brachytherapy – the implantation of radioactive seeds directly into the prostate.
The scientific team, led by radiation oncologist Paul Nguyen, MD, and medical student Arti Parekh, said it is the first study to link men's perceptions of a reduction in penis size to lowered life satisfaction, problems in emotional relationships, and misgivings about the specific form of prostate cancer treatment they chose.
Nguyen said that the potential side effect of a smaller penis is well-known among physicians and surgeons.
"But it's almost never discussed with patients, so it can be very upsetting to some men when it occurs," he added. "Patients can deal with almost any side effect if they have some inkling ahead of time that they may happen."
The report's authors said physicians should discuss the possibility with their patients so that they can make more-informed treatment choices.
There were no direct measurements of penis size either before or after treatment, said the researchers. Nor did the patients' physicians specifically ask about this side effect; the issue was brought up by patients in conversations with their doctors. For this and other reasons, the authors of the new study suggest that the problem is likely more common than reported in the survey.
"Prostate cancer is one of the few cancers where patients have a choice of therapies, and because of the range of possible side effects, it can be a tough choice," said Nguyen. "This study says that when penile shortening does occur, it really does affect patients and their quality of life. It's something we should be discussing up front so that it will help reduce treatment regrets."
The likelihood and magnitude of penis shortening as a consequence of treatment have not been well studied, said the researchers.
However, Jim Hu, MD, a surgeon at the University of California, Los Angeles Medical Center and a co-author of the study, said: "Previous studies have concluded that there is shortened penis length following prostatectomy. This is most common with non-nerve sparing surgery, as this may result in fibrosis and atrophy of erectile tissue due to damage to nerve and vascular structures." The present study did not find much difference on that score.
The study's subjects were men enrolled in a registry called COMPARE that collects data on patients whose prostate cancer shows signs of recurring after initial treatment. Of the 948 men in the study, 22% were younger than 60 and the majority were in their 60s, 70s and 80s. Just over half – 54% – had undergone surgery to remove their cancerous prostate, while 24% received radiation therapy combined with hormone-blocking treatment, and 22% had radiation therapy alone.
In an editorial comment accompanying the report, Luc Cormier, MD, PhD, of Dijon University Hospital in France said the study "is really of interest because of the number of patients and that it included other treatment methods in addition to radical prostatectomy."
The surveys of the men did not report on their sexual functioning. Cormier observed that "sexual activity needs to be thoroughly measured owing to the obvious relationship with the patients' perception of penile length."
Also on HuffPost UK Lifestyle:
Broccoli And Broccoli Sprouts
Cruciferous vegetables, but broccoli in particular, make for anti-cancer powerhouses thanks in part to a compound called sulforaphane that actually helps the body fight the spread of tumors. Recent research revealed the underlying reason: sulforaphane may inhibit an enzyme, called an HDAC, that <a href="http://www.huffingtonpost.com/2012/02/29/broccoli-cancer-sulforaphane_n_1310634.html">works to suppress the body's tumor fighting ability</a>, as we've previously reported. And sprouts are even more potent: three-day old broccoli sprouts have 20 to 50 times the sulforaphanes as mature broccoli, <a href="http://www.hopkinsmedicine.org/press/1997/sept/970903.htm">according to Johns Hopkins research</a>. For more about the cancer fighting properties of <em>all cruciferous vegetables, check HuffPost blogger Dr. Joel Fuhrman's <a href="http://www.huffingtonpost.com/joel-fuhrman-md/cancer-prevention_b_1624965.html">analysis of cabbage, brussels sprouts, bok choy and more</a>.
Garlic is considered a cancer-fighting food for several forms of the disease, <a href="http://www.cancer.gov/cancertopics/factsheet/prevention/garlic-and-cancer-prevention#r12">according to the National Cancer Institute</a>. One French study found that women who regularly ate garlic had <a href="http://www.ncbi.nlm.nih.gov/pubmed/9928867">a significantly reduced risk of breast cancer</a>. Garlic's mild cousin, onions also had a protective effect, according to the study.
Pomegranates are known for their anti-cancer properties, thanks to a richness in anti-inflammatory antioxidants, polyphenols. But they may offer a specific benefit against breast cancer: research shows that a phytochemical found in abundance in pomegranates, called ellagitannins, interfere in the production of aromatase, an enzyme that, as HuffPost blogger Dr. Nalini Chilkov explained, "<a href="http://www.huffingtonpost.com/nalini-chilkov/pomegranates-cancer-fighting-_b_1078343.html">increases hormone production in breast tissue</a>." That's important because breast cancer is hormone-dependent, meaning that it feeds off of hormones like estrogen to grow and spread. "Hormone dependent cancers such as breast cancer are commonly treated with aromatase inhibitors, which block this enzyme," wrote Chilkov.
Although preliminary, research in mice has found that <a href="http://www.sciencedaily.com/releases/2011/09/110901163921.htm">including walnuts in a healthful diet throughout the entire lifespan</a> reduced the risk of developing breast cancer by <em>half</em>.
Curcumin, the compound in turmeric, may play a role in blocking the expression of a molecule called RANKL, <a href="http://www.huffingtonpost.com/nalini-chilkov/turmeric-health-benefits-_b_828856.html">which is found in the most deadly and aggressive breast cancer tumor cells</a>.
Most research regarding flax's anti-cancer properties has been done in mice or in-vitro cell cultures, but what it shows could be profound: in one study, according to the American Cancer Society, <a href="http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/flaxseed">the lignans found in flax slowed the movement and "stickiness" of breast cancer cells</a>, causing it to spread more slowly in a cell culture simulation.
Berries have several powerful antioxidants, primarily anthocyanins and ellagic acid, which have been shown in cell culture studies to <a href="http://www.aicr.org/foods-that-fight-cancer/blueberries.html#research">reduce free radical damage to healthy cells</a>, according to the American Institute for Cancer Research. In separate research, they were shown to slow the growth and shorten the lifespan of breast cancer (as well as mouth, colon and prostate cancer) cells.
Green tea is rich in the polyphenol EGCG (epigallocatechin-3-gallate), which has been shown to slow the spread of breast cancer cells, <a href="http://www.breastcancer.org/tips/nutrition/supplements/known/green_tea">according to breastcancer.org</a>.
Tomatoes are rich in the antioxidant lycopene, which is thought to <a href="http://www.msnbc.msn.com/id/39726407/ns/health-cancer/t/what-you-should-eat-avoid-beat-breast-cancer/#.UHNMJvmMG5M">slow breast cancer cell growth</a>.